title: Feasibility, acceptability and preliminary effectiveness of patient advocates for improving asthma outcomes in adults.
abstract: BACKGROUND
  Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication. We adapted a patient advocate (PA) intervention to overcome these barriers.
  
  
  OBJECTIVE
  To conduct a pilot study to assess feasibility, acceptability and preliminary evidence of effectiveness.
  
  
  METHODS
  A prospective randomized design was employed with mixed methods evaluation. Adults with moderate or severe asthma were randomized to 16 weeks of PA or a minimal intervention (MI) comparison condition. The PA, a non-professional, modeled preparations for a medical visit, attended the visit and confirmed understanding. The PA facilitated scheduling, obtaining insurance coverage and overcoming barriers to implementing medical advice. Outcomes included electronically-monitored inhaled corticosteroid (ICS) adherence, asthma control, quality of life, FEV1, emergency department (ED) visits and hospitalizations. Mixed-effects models guided an intention-to-treat analysis.
  
  
  RESULTS
  100 adults participated: age 47 ± 14 years, 75% female, 71% African-American, 16% white, baseline FEV1 69% ± 18%, 36% experiencing hospitalizations and 56% ED visits for asthma in the prior year. Ninety-three subjects completed all visits; 36 of 53 PA-assigned had a PA visit. Adherence declined significantly in the control (p = 0.001) but not significantly in the PA group (p = 0.30). Both PA and MI groups demonstrated improved asthma control (p = 0.01 in both) and quality of life (p = 0.001, p = 0.004). Hospitalizations and ED visits for asthma did not differ between groups. The observed changes over time tended to favor the PA group, but this study was underpowered to detect differences between groups.
  
  
  CONCLUSIONS
  The PA intervention was feasible and acceptable and demonstrated potential for improving asthma control and quality of life.
authors.affiliation: Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine .
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Fei
authors.initials: F
authors.lastname: Wan
authors.forename: Susan
authors.initials: S
authors.lastname: Reisine
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Bogen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.forename: Bruce
authors.initials: B
authors.lastname: Bender
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Rodalyn
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Chantel
authors.initials: C
authors.lastname: Priolo
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.forename: Monica
authors.initials: M
authors.lastname: Ferguson
authors.forename: Rhonda C
authors.initials: RC
authors.lastname: Boyd
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005541:Forced Expiratory Volume; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010344:Patient Advocacy / Q000592:standards*; D015143:Philadelphia; D010865:Pilot Projects; D011203:Poverty; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents